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ITALIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY

A Journal on Vascular and Endovascular Surgery


Official Journal of the Italian Society of Vascular and Endovascular Surgery
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Giornale Italiano di Chirurgia Vascolare 2003 March;10(1):1-14

language: English, Italian

Minilaparotomy in aortic surgery. Benefits of the technique and comparison with midline and flank incision

Peinetti F., Maione M., Cifiello B. I., Piccolo D., Imperial H.

Unità Operativa di Chirurgia Vascolare ed Angiologia Ospedale Regionale Valle d’Aosta, Aosta


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Back­ground. Endo­vas­cular and lapar­os­copic tech­niques con­tinue to be devel­oped in the ­attempt to fur­ther estab­lish alter­na­tive ­safe, dur­able tech­niques to ­treat aor­toi­liac dis­ease. In our expe­ri­ence we intro­duced the ­left sub­costal min­i­lap­a­rotomy in 1998, for a ­less ret­ro­per­i­to­neal dis­sec­tion of the abdom­inal ­aorta. The advan­tage of min­i­lap­a­rotomy ­aortic expo­sure to ­treat ­aortic dis­ease (AAA and PAD) was ana­lysed in com­par­ison ­with con­ven­tional ­open ­repair ­with mid­line or ­flank inci­sion ­with exten­sive ret­ro­per­i­to­neal dis­sec­tion.
­Methods. ­From Jan­uary 1998 to ­December 2000, 134 ­patients under­went sur­gery for ­aortic dis­ease in the Vas­cular Sur­gery and Angi­ology ­Unit, ­Aosta ­Valley ­Regional Hos­pital. ­They ­were sub­di­vided ­into 3­groups by sur­gical ­approach: 1) ­group A: mid­line inci­sion (52 ­patients: 40%); 2) ­group B: ­flank inci­sion (44 ­patients: 33%); 3) ­group C: ­left sub­costal min­i­lap­a­rotomy (38 ­patients: 27%). We eval­u­ated clin­ical char­ac­ter­is­tics, mor­tality, mor­bidity, ­early and ­late com­pli­ca­tions, ­length of hos­pi­tal­isa­tion, com­paring ­them ­among the 3 ­groups.
­Results. No sta­tis­ti­cally sig­nif­i­cant dif­fer­ence was ­found ­among the 3 ­groups for age, ­gender, ­risk fac­tors or asso­ciated vas­cular dis­ease. Oper­a­tive mor­tality and mor­bidity and ­were ­also com­par­able ­among the 3 ­groups. The ­results for ­group C dem­on­strate the poten­tial advan­tage of min­i­mally inva­sive sur­gical tech­niques: ­early ­removal of nas­o­gas­tric suc­tion, ­quicker pro­gres­sion to reg­ular ­diet and ­mobility, ­shorter hos­pi­tal­isa­tion.
Con­clu­sions. ­Based on our pre­lim­i­nary expe­ri­ence, we con­clude ­that treat­ment of aneu­rysm or ­aortic dis­ease ­with min­i­lap­a­rotomy ­repair ­leads to a sig­nif­i­cant improve­ment in ­recovery ­without sig­nif­i­cant ­changes in mor­bidity or mor­tality. It is a fea­sible and ­safe tech­nique ­offering ­long-­term dur­ability, and is a ­safe alter­na­tive to be con­sid­ered by the vas­cular sur­geon.

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